Post-traumatic stress disorder in adolescents after witnessing violent crime

Abnormal Behavior: Three Case Studies

Case

In the case of this young man, the feelings and behaviors he is exhibiting are far from 'abnormal.' In fact, it could be argued that it would be far more abnormal to have no appreciable reaction after witnessing such a traumatic event as a robbery and a murder. The fact that he was unable to prevent the victim's death after calling 911 makes the event even more horrifying. However, although the teenager's feelings could be called normal in terms of the fact that it is extremely common to experience psychological difficulties after witnessing a violent action, it could be argued that his reaction is abnormally extreme. However, different people experience different levels of distress after experiencing trauma. Some individuals are relatively unscathed, while others suffer difficulties for years afterwards. A comparable experience is being in a war: while war is 'hell,' not every soldier feels was is equally hellish. Some soldiers enlist for prolonged periods of time, while others become shell-shocked very quickly.

But merely because some teens might not have the same reaction to witnessing the robbery as this young man does not mean that he is 'abnormal.' In this case, a better definition of abnormality might be that his emotional instability is abnormal compared with his usual optimal level of functioning. It is abnormal because it is interfering with his normal, daily life activities that were previously pleasurable. In the scenario, the man's competence in seeking aid and circle of friends suggest a relatively stable personality. His current state of anxiety, in other words, is abnormal for him, even though it is not eccentric or deviant (in fact, someone with a sociopathic or deviant personality might not feel particularly upset at witnessing a violent event, and feel no empathy with the victim).

Labeling the teen's case 'post-traumatic stress disorder' and giving it a diagnosis of abnormality makes it easier for the teen to identify his pattern of symptoms as part of a syndrome, rather than as an example of being weak-willed and unable to cope with life. Pointing out the connections between the trauma experienced by soldiers and by others who have seen terrible incidents may make the teen feel stronger, rather than weaker, after being diagnosed: he will know that hardened soldiers have felt the same type of emotions as he has, and exhibited similar symptoms.

Part B

Not every person experiences trauma in the same way: it is possible that someone who was brought up in an atmosphere of extreme violence would not be as affected as this teen (although some might argue that people who live in crime-ridden areas also often experience PSTD, but are not always diagnosed because they cannot or do not seek counseling). Some people might find it easier to talk about the incident than others; some might feel driven to become a policeman; others might want to buy a gun and/or take martial arts classes. This teen has become withdrawn. While not every teen might experience trauma in the same way or have PTSD, trauma is evident in all of these possible reactions. Personality type, immediate availability of support, self-knowledge about one's reaction, and the reactions of friends and loved ones nearby will all influence the individual's response to trauma. A genetic tendency towards developing anxiety can also increase the tendency to have such symptoms.

Part B

Culture as a whole has partially created this problem of Internet addiction -- much like certain societies and subcultures can facilitate alcohol or drug addiction. The technology is highly available, and is also, on a biological level, much like drugs or gambling, a highly simulative behavior. Getting a reply from someone, like playing a slot machine or going on a shopping binge, can be a way to deal with negative emotions with a 'quick fix.' Some individuals are biologically more vulnerable to addictive behaviors, and a fear of dealing with emotions in a real and genuine fashion can also be masked through the Internet's presence. The use of social media everywhere in society and even people with full lives (social lives, jobs, and classes) use the technology constantly.

However, someone who is insecure, with addictive tendencies, and is transitioning into a new life stage can become more vulnerable to addiction: for example, many teens binge drink, but not all drink themselves to the point where they stop attending classes and doing homework; many teens use the Internet constantly, but not all do it to the exclusion of classes and other activities. In fact, for many healthy teens, the Internet is merely a tool to facilitate their enjoyment and pursuit of excellence in real life activities. For this young woman, the Internet has become a substitution for a real connection with others, rather than a way of improving her life off-line.

Part C

This behavior is changeable -- going on a social media and Internet 'diet' or quitting cold turkey under the supervision of a counselor might be advisable. Cognitive behavioral therapy has been useful in de-conditioning addictive behaviors. Behavioral therapy can help the individual understand some of the irrational thoughts and behavior patterns that make them use addiction rather than more positive strategies to deal with life stressors.

Case 3

Part A

Gender identity disorder simply means that an individual identifies with the opposite gender: for example, a male may identify with females or a female might identify with males. Quite often the individual feels disgust at his or her physical evidence of maleness or femaleness, and engages in stereotyped behaviors associated with the opposite gender.

This boy's behavior is clearly abnormal in the sense that it flies in the face of conventional social dictates. Furthermore, there is evidence that the individual feels distress: for example, the boy expresses dislike at the fact that he has a penis, as opposed to a vagina. This is not simply an instance of a boy play-acting being a female. The distress is not purely due to social censure, given that the parents support the boy, and the boy is evidently treated as a girl in the eyes of the school.

Forcing transgendered people to change at any age is usually futile, and could increase rather than alleviate any trauma the boy feels regarding his identity. However, given the difficulties the boy may experience in the future, encouraging the parents to get the boy counseling, without labeling the boy as 'abnormal' would be a wise step.

Part B

The reasons that individuals identify with opposite-gendered behaviors and physicality are not clearly understood, even by the individuals themselves. Adults who select sexual reassignment surgery often say that they never felt as if they could express their true selves, before surgery. However, in the case of this young boy, it is uncertain whether he will select such surgery in the future. His character is still unformed.

Given the age of the boy, it would seem wisest to support him in his choice, as his parents have, but without labeling his behavior as conclusively masculine or feminine. Even if hormone imbalances or biologically-based reasons are at the root of his condition, no type of physical remedy will 'cure' the boy, nor will forcing him to dress or behave in a more conventionally masculine fashion.

Part C

The reasons that individuals identify with members of the other gender are uncertain. It is not clear if the boy can or should be 'treated' -- however, counseling and support will make whatever he experiences in life, or whatever he chooses in the future easier to bear. For a young child, engaging in play therapy, or having a 'safe space' to talk about his feelings might be the most valuable treatment the counseling profession has to offer him at this time.